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The patient came to the
clinic 06-January-2008 complaining of neck and
left upper limb pain for 45 days. MRI of the
cervical spine performed 01-January-2008 showing
extruded disc C6-7 left side and bulge C5-6. |
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The patient walking with
crutches after falling down 2 months ago. The
patient was operated 13 years ago for PLD L5-S1
after what he complained of left sciatica and
almost drop left foot with anaesthesia of the
left L5 territory. For the cervical pathology,
the patient was advised to try conservative
treatment. |
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The patient came
09-January-2008 with MRI lumbar spine performed
14-September-2007 showing recurrence of PLD. |
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The patient was sent for
another MRI, which was performed 11-January-2008
showing assimilation of L5 with S1 with
recurrent disc L4-5 with left downward migration
and possible intradural involvement. |
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Using image-intensifier, the
level was identified and left L4-5 hemiflavotomy
with left L5 foraminotomy was performed. The
extruded disc was attacked lateral to the
axilla. Piecemeal resection of the extrusion was
done using micropituitaries from the
percutaneous kit. After removing the
intradurally extruded disc fragments CSF came
out. The dural defect was closed with 2 nylon 6
zero stitches and covered with thread of muscle.
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The disc space was very
shallow and cleaning from the left side was
performed. |
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Routine closure of the wound. |
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Smooth postoperative recovery
and the power of the left foot dorsiflexion
improved. |
